Eligibility and Benefits

MedPOINT Management’s eligibility department tracks and maintains current and historical eligibility information for all contracted health plans.

Eligibility is updated on a daily, weekly, semi-monthly, and/or monthly schedule as it is received from the health plan. Reconciliations are performed using Eligibility Manager and Data Tug software. Eligibility is also updated on an ‘as needed’ basis when authorizations or claims are received for members not in the system. A detailed eligibility list is posted monthly for each Primary Care office and/or Clinic. Our provider web portal also posts current member lists for each office to utilize.

Staff configure benefit tables for each health plan benefit option to identify exclusions and provide co-pay information for each service. This information is integrated for accurate authorization and claims adjudication processes.